The founding of ReaMetrix marked Bala Manian's reinvolvement with Indian
business and technology issues after a more than 30-year hiatus. ReaMetrix is a
cutting edge life science company continuing Bala's tradition of high tech
solutions to problems with offices in San Carlos, California and Bangalore. It
has recently developed Accuford TriTStat assay, a critical diagnostic for
managing HIV patients, that could entirely alter the cost paradigm for
conducting HIV tests.

How different is ReaMetrix in India?

ReaMetrix was started with the idea that we were going to use
the availability of highly talented people, scientific talent available at a
lower cost to do things that can no longer be done in the US. That was the
promise with which ReaMetrix was started. In a fairly short period of time, it
became clear that the local economic paradigm subconsciously influences every
decision that we make. For example, when I am designing a process in the US,
subconsciously, I am willing to accept a high material cost to save labor, as
labor is more expensive than material in the US. It is just the opposite here in
India. We realized that what we really need to do is not simply bring the
process over here. Because if we do that, all we do is the saving of the labor
cost. But when we actually redesign the process, based on the labor that is
available, then we have a more optimal process over here. For example, in the
US, I may be willing to accept 15 percent yield by material because the labor
that is required to improve that yield is too expensive. Over here, I can use
the labor and improve the yield from 15 percent to 40 percent. So we not only
get the cost savings on the labor, we also now improve the whole efficiency of
the process. The realization is that if we are going to do diagnostics in India,
the idea is not to bring the procedures from the US. Just bring the science from
the US. Import the science but implement the science in the local context. Our
Accuford TriTStat is that first proof of principle of that concept.

What is the other differentiation?

Generally, one tends to focus on technology providing all the
solutions. But what we are doing at ReaMetrix is simply reversing that paradigm.
We put the affordability index first. We define affordability of the task as our
target and then find the right technology and the right processes that is going
to allow us to deliver the goods and services with that kind of affordability
index. In a lot of ways, in trying to do the TriTStat test, we set the goal of
what it has to cost and then optimize the process to be able to design.

What is Accuford TriTStat?

The Accuford TriTStat assay has been developed and
manufactured by ReaMetrix Corp. as a critical diagnostic for managing HIV
patients. The product will be marketed by Millipore India. Our reagent kit
provides the consumables for the enumeration of a patient's T-cells on a flow
cytometer. The key component of this test are fluorescently-labeled monoclonal
antibodies. While the raw materials for the test are imported from established
suppliers in developed nations, the process for creating a clinically useful kit
is carried out entirely in India.

These reagents will identify particular number of subset of
cell. If you take one drop of blood, one microlitre, one cubic millimeter of
blood, there are 5 million red blood cells in there, approximately 7,100 white
blood cells. Out of that 7,100, there are 900 CD4 positive T-cells and 600 CD8
cells. It is the 900 and 600 cells that we are trying to look at. So it is truly
looking for a needle in a haystack. And the way you identify them is you take
the antibodies that are specific to CD3 and CD4 and you put different colored
florochromes on it. And then when it binds to the cell in the flow cytometer,
you count the number of events - number of white cells going by and see if it
is positive for CD3 and CD4. If it is positive for CD3 and CD4, then it is a T
cell - TCD4 cell. So you count them and you report the result as so many cells
per microlitre. That is the result we provide.

How affordable are your products?

Lets take Becton Dickinson (BD) or Beckham Coulter. These are
the two major players in this segment. They sell the machines and also the
reagents. The reagents are sold at Rs 600- 800 depending on the volume
commitment and so on. So the reagents are made in the US. In their case, they
add all the value in the US. The raw material that we do is very similar to
theirs. So there is no difference between the two, except we add all the value
in terms of kit preparation, validation, etc. in Bangalore and we optimize our
processes based on the economics over here. And that is the reason why we are
able to bring the costs down.

We have started supplying the reagents to Anand Diagnostics.
It used to charge about Rs 1,200 for this test. It is paying about Rs 700 for
the imported reagent from BD. We are supplying the same reagent to it under Rs
150. So we are talking about reducing the price by a factor of five. We had an
agreement with it so that it does not pocket the money all by itself. It has
reduced the price to the customer to Rs 500. What is interesting is, before our
reagents came into the picture, it was doing only about 4-5 tests a day. Now it
is doing about 15 tests a day. We want to use this as an example to change the
dynamics.

In a developed country, somebody may have the test done once
every two months and in India right now because the cost is so high, typically
they do only two tests a year. There is a companion test or a viral test.
Actually we are working on an alternative for that as well. That costs Rs 3,000
to Rs 4,000 and lets say this is Rs 2,000 to do the test. The combination of the
two tests is about Rs 5,000 and two tests a year would mean Rs 10,000. Now Cipla
sells the whole drug for an entire year for Rs 15,000. So when testing for twice
a year is as expensive as the drug itself, it is not fair. What we talking now
is reducing the cost immediately. We think a combination of the two tests should
be available in the price range of Rs 1,000-1,200. And if you do four tests a
year, it will still be Rs 5,000. This is including the viral test. In fact the
more tests we put in, the price will come down. Then the other viral load right
now costs Rs 2,500. We would like to develop an alternative test to bring that
price down as well. So the entire testing burn for managing AIDS patient should
really be brought down. That's how we go. So rather than focusing on a menu of
tests, we are going to focus on the disease.

What are you product expansion plans?

We are currently focusing on making the reagents, by
optimizing the process by which we produce the reagents. The second step is to
modify it in a dry form so that we can deliver it wherever it needs to be
delivered without having to worry about the cold chain requirements. The third
step is to build our own hardware platform so that we can provide a complete
solution. This platform will be a flow cytometer-type platform but based on
today's generation of technology.

Why have you chosen Millipore as your
partner, which is not a diagnostics supplier?

Our third philosophy is that we are not going to go and
accept either a product concept or a test concept that has been used in the West
but rather we want to find out from the market place, what is the right test
that is required in the Indian context. Our new ideas are going to come from our
customers. So it became clear to us that we cannot just go and find a
distribution channel that just sells our products but rather a distribution
channel that can own the customer and work with the customer. In India, an
existing distribution channel typically has a trading mindset. And that is the
reason why ReaMetrix formed this strategic relationship with Millipore India. I'm
more interested in the fire under the belly and the gleam in the eye than the
past experiences.

Why is it called TriTStat?

Tri is because we look at three different markets-CD3, CD4
and CD8. You need all of those to get the count of CD4, CD8. And we will report
how many cells are CD3 positive, how many cells are CD3 and CD4 positive, how
many cells are CD3 and CD8 positive. Right now the largest use is for managing
HIV patients. But in general this is used to assess the immune system. There are
lots of other diseases in which you want to know the immune system, even in some
of the autoimmune diseases. That is why it is called TriTStat. "T" is
the T cells that we are talking about. Stat is the status of the T cells.

Accuford is the brand name we are establishing which stands
for accuracy and affordability. It is affordability without compromising
accuracy. Accuford is the brand name, which is really the theme behind what we
are doing.